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Sherman AD, Febres-Cordero S, Bonds Johnson K, Clark KD, Klepper M, Duroseau B, Lin Y, Zhang W, Coleman M, Prakash D, Daniel GA, Chand AT, Kalu U, Tarter R, Allgood S, Cohen S, Kelly U, Balthazar M. Intersectionality in nursing research: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023; 5:100155. [PMID: 37982092 PMCID: PMC10655863 DOI: 10.1016/j.ijnsa.2023.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023] Open
Abstract
Background An intersectional approach to health research provides an analytical foundation to explain the multidimensionality of health status, resource accessibility, privilege, oppression, and current and historical context. The use of intersectionality in health research has known limitations. Its use in health-related fields too often focuses on outcomes, such as health disparities, rather than processes, such as power structures and social determinants. Objective This scoping review serves to examine how intersectionality has been implemented by nurses in the peer-reviewed literature. We offer insight into how it may be incorporated to inform future nursing research and healthcare provision. Design & Methods Systematic searches of PubMed (n = 257), SCOPUS (n = 807), EMBASE (n = 396), CINAHL (n = 224), and Health Source: Nursing and Academics (n = 491), published since the seminal publication on intersectionality (1989 - 2023), identified 131 research articles that met inclusion and exclusion criteria. Data extraction and synthesis were used to describe the breadth and depth of the literature specific to the application of intersectionality in nursing research. Results The included studies used intersectionality to examine the intersections of numerous identities, such as race, gender, and immigration status. However, most studies were descriptive/observational in nature, underreported their methods, and conducted deficit-based research instead of strength-based inquiries. Of note, the vast majority of included articles were published within the last five years. Conclusions Future researchers using intersectionality as a framework can improve their approach by reporting clear definitions and operationalization of intersectionality. Observational science dominated the included studies; future research should focus on intervention development and evaluation using an intersectional lens. Lastly, caution should be placed on research that focuses solely on deficits among marginalized communities, which places scientists at risk of perpetuating stereotypes or enhancing already-existing stigmas.
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Affiliation(s)
- Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH, USA
| | | | | | - Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Mercy Coleman
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Diane Prakash
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Gaea A. Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Arzina Tabassum Chand
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Ugo Kalu
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Robin Tarter
- Oregon Health and Science University, Portland, OR, USA
| | | | - Sydney Cohen
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Monique Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
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Ngowi K, Msoka P, Mtesha B, Kwayu J, Mappi T, Kiwango K, Kiwelu E, Mmasi T, Sichalwe A, Shayo BC, Maro E, Marion Sumari-de Boer I. "The phone number tells us good things we didn't know before." Use of interactive voice response calling for improving knowledge and uptake of family planning methods among Maasai in Tanzania. PLOS DIGITAL HEALTH 2023; 2:e0000254. [PMID: 37205646 DOI: 10.1371/journal.pdig.0000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023]
Abstract
Maasai living in the Arusha region, Tanzania, face challenges in feeding their children because of decreasing grazing grounds for their cattle. Therefore, they requested birth control methods. Previous studies have shown that lack of knowledge about, and poor access to, family planning (FP) may worsen the situation. We developed an interactive voice response calling (IVRC) platform for Maasai and health care workers (HCW) to create a venue for communication about FP to increase knowledge and access to FP. The objective of this study was to explore the effect of the platform on knowledge, access and use of family planning methods. We applied a participatory action research approach using mixed methods for data collection to develop and pilot-test an mHealth-platform with IVRC using Maa language. We enrolled Maasai-couples and HCW in Monduli District (Esilalei ward), Arusha Region, and followed them for 20 months. A baseline assessment was done to explore knowledge about FP. Furthermore, we abstracted information on FP clinic visits. Based on that, we developed a system called Embiotishu. A toll-free number was provided to interact with the system by calling with their phone. The system offers pre-recorded voice messages with information about FP and reproductive health to educate Maasai. The system recorded the number of calls and the type of information accessed. We measured the outcome by (1) a survey investigating the knowledge of contraceptive methods before and after Embiotishu and (2) counting the number of clinic visits (2018-2020) from medical records and feedback from qualitative data for FP used among Maasai. The acceptability and feasibility were explored through focus group discussions (FGDs) with Maasai and in-depth interviews (IDIs) with HCW. We recruited 76 Maasai couples whom we interviewed during the baseline assessment. The overall knowledge of contraceptives increased significantly (p<0.005) in both men and women. The number of clinic visits rose from 137 in 2018 to 344 in 2019 and 228 in the first six months of 2020. Implants were the most prescribed family planning method, followed by injections and pills, as found in medical records. The number of incoming calls, missed calls, and questions were 24,033 over 20 months. Out of these calls, 14,547 topics were selected. The most selected topics were modern contraceptives (mainly implants, condoms, tubal ligation, and vasectomy). Natural methods of contraception (vaginal fluid observations, calendar, and temperature). Our study has shown that the IVRC system led to an improvement in knowledge about and access to contraceptives. Furthermore, it has potential to increase access to health information as well as improve dialogue between Health workers and Maasai.
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Affiliation(s)
- Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Perry Msoka
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Amsterdam Institute for Social Science Research (AISSR), Amsterdam, The Netherlands
| | - Benson Mtesha
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Jacqueline Kwayu
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania
| | - Tauta Mappi
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Krisanta Kiwango
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Ester Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Titus Mmasi
- The office of District Medical office, Monduli, Arusha, United Republic of Tanzania
| | - Aifello Sichalwe
- The office of Regional Medical office, Arusha, United Republic of Tanzania
| | - Benjamin C Shayo
- Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania
- Baylor College of Medicine, Houston, Texas, United States of America
| | - Eusebious Maro
- Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania
| | - I Marion Sumari-de Boer
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Knowledge, Technology and Innovation Group, Wageningen University & Research, Wageningen, the Netherlands
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Assessing motivators for utilizing family planning services among youth students in higher learning institutions in Dodoma, Tanzania: Protocol for analytical cross sectional study. PLoS One 2023; 18:e0282249. [PMID: 36897915 PMCID: PMC10004694 DOI: 10.1371/journal.pone.0282249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/11/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Contraceptive services utilization is an important intervention in averting the impact of unwanted and unplanned pregnancy among youth which is an obstacle to the higher learning institutions youth students in attaining their educational goals. Therefore, the current protocol aims to assess the motivators for family planning service utilization among youth student in higher learning institutions in Dodoma Tanzania. METHODS This study will be a cross-sectional study with quantitative approach. A multistage sampling technique will be employed in studying 421 youth students aged between 18 to 24 years using structured self-administered questionnaire adopted from the previous studies. The study outcome will be family planning service utilization and independent variables will be family planning service utilization environment, knowledge factors, and perception factors. Other factors such as socio-demographic characteristics will be assessed if they are confounding factors. A factor will be considered as a confounder if it associates with both the dependent and the independent variables. Multivariable Binary logistic regression will be employed in determining the motivators for family planning utilization. The results will be presented using percentages, frequencies, and Odds Ratios and the association will be considered statistically significant at p-value <0.05.
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Aristide C, Bullington BW, Kuguru M, Sundararajan R, Nguyen NT, Lambert VJ, Mwakisole AH, Wamoyi J, Downs JA. Health providers' perspectives on contraceptive use in rural Northwest Tanzania: A qualitative study. Contracept X 2022; 4:100086. [PMID: 36324829 PMCID: PMC9618975 DOI: 10.1016/j.conx.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 07/29/2022] [Accepted: 09/23/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives In Tanzania, contraceptive use is limited, particularly in rural communities and even among women who would like to delay childbearing. This paper aims to present health providers' perspectives on populations seeking contraception and barriers that could be addressed to increase access to and uptake of contraception, given their interface with large portions of their communities. Study Design We conducted 18 in-depth interviews with providers stationed at health dispensaries in six rural villages in northwest Tanzania. Two investigators independently coded interviews using a stepwise process to achieve consensus on prevalent topics. Results Three topics emerged from our analysis: (1) nature of clients seeking contraception; (2) barriers to uptake of contraception; and (3) the role of secrecy in obtaining and using contraception. Health providers reported that married women with children were the most frequent users of contraception, alongside some single women, men, sex workers, and students. Barriers to contraception included lack of supplies and trained staff, misconceptions and fears, stigma, and unsupportive partners. Providers observed that contraception was often used secretly. They reported surreptitious visits and described clients' preferential use of discreet methods. Providers respected and supported clients' desires to keep visits confidential. Conclusion Our data suggest maintaining high stocks of discreet contraceptive methods and deploying more trained staff to dispensaries could increase availability and access to contraceptives. At the community level, more education campaigns are warranted to address barriers, especially those related to stigma. Implications Our work highlights the need for additional contraceptive methods that are easy to administer and discreet for women who must maintain secrecy. Future studies of the effectiveness of interventions and new contraceptives should obtain healthcare providers' perspectives, as they can provide important insights to service provision.
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Affiliation(s)
- Christine Aristide
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
- Corresponding author.
| | - Brooke W. Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Natalie T. Nguyen
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
| | | | | | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jennifer A. Downs
- Center for Global Health, Weill Cornell Medicine, New York City, NY, USA
- Department of Medicine, Bugando Medical Center, Mwanza, Tanzania
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Gage AJ, Wood FE, Kittoe D, Murthy P, Gay R. Association of Male Partners' Gender-Equitable Attitudes and Behaviors with Young Mothers' Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12182. [PMID: 36231485 PMCID: PMC9565980 DOI: 10.3390/ijerph191912182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Inequitable gender norms can contribute to rapid repeat pregnancies and adverse maternal health outcomes among adolescent girls and young women. This study examined associations between male partners' gender-equitable attitudes and behaviors and postpartum family planning (FP) and maternal and newborn health (MNH) outcomes among first-time mothers aged 15-24 in Kinshasa, Democratic Republic of the Congo. Participants were 1335 couples who were successfully interviewed in the Momentum project's 2018 baseline and 2020 endline surveys. Multivariable regression models were used to analyze predictors of postpartum FP discussion and use, shared MNH decision making, completion of the maternal health continuum of care, and exclusive breastfeeding. Male involvement in maternal health was significantly associated with FP discussion and shared decision making. Male partners' willingness to be involved in routine childcare and shared decision making were significant positive predictors of exclusive breastfeeding. Postpartum FP outcomes were shaped by the intersection of marital status and male partners' gender-equitable attitudes, intimate partner violence perpetration, and willingness to engage in routine childcare activities to constitute advantage for some outcomes and disadvantage for others. Interventions must use multiple measures to better understand how young mothers' health outcomes are shaped by their male partners' gender-related attitudes and behaviors.
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Affiliation(s)
- Anastasia J. Gage
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Francine E. Wood
- Center on Gender Equity and Health, University of California San Diego, La Jolla, CA 92093, USA
| | - Darling Kittoe
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Preethi Murthy
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Rianne Gay
- Tulane International LLC, Ngaliema, Kinshasa, Democratic Republic of the Congo
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